International Journal of Medical Science and Pharmaceutical Research

Background: Long-term benzodiazepine (BZD) use remains a major clinical challenge because discontinuation may be complicated by physical dependence, rebound symptoms, recurrence of the underlying disorder, withdrawal manifestations, and psychological reliance on medication. Although gradual individualized reduction remains central to deprescribing, successful discontinuation may also depend on educational, behavioral, pharmacological, and complementary interventions.

Objective: To provide a clinically oriented narrative review of conventional, pharmacological, behavioral, and complementary strategies used to facilitate long-term BZD discontinuation, with particular attention to quantitative outcomes and the distinction between dose reduction, complete discontinuation, sustained discontinuation, and withdrawal tolerability.

Methods: Human studies directly addressing BZD or related sedative-hypnotic reduction or discontinuation were reviewed, including systematic reviews, meta-analyses, randomized and nonrandomized trials, and observational studies. Complementary interventions were evaluated using the same outcome-oriented framework as conventional treatments. Studies addressing only anxiety or insomnia without a BZD-discontinuation context were considered indirect evidence.

Results: Structured withdrawal and brief interventions increased cessation compared with usual care, with odds ratios of 5.96 and 4.37, respectively. Direct patient education resulted in 27% versus 5% discontinuation at 6 months in the EMPOWER trial. CBT combined with supervised withdrawal produced complete discontinuation rates ranging from approximately 75% to 85% in selected trials, with benefits persisting for up to 12 months. Pharmacological adjuncts showed heterogeneous results; pooled melatonin data did not demonstrate increased complete discontinuation. Complementary approaches produced heterogeneous quantitative findings. At 12 months after E2R hypnotherapy, 57.5% had completely discontinued medication and 79.5% had reduced or stopped it. Adjunctive Passiflora incarnata was associated with ≥50% BZD reduction in 95.69% versus 72.04% of controls and complete discontinuation in 69.89% versus 52.69% at 3 months. A multicomponent program incorporating balneotherapy produced 75.3% overall reduction and 41.4% complete discontinuation at 6 months. Controlled acupuncture studies yielded differing results.

Conclusions: BZD deprescribing should not be represented by a single binary endpoint. Dose reduction, complete discontinuation, sustained discontinuation, and withdrawal tolerability are clinically distinct outcomes. The available evidence supports individualized, patient-centered, and frequently multicomponent management, with conventional and complementary interventions evaluated according to study design and quantitative outcomes rather than treatment category alone.

Benzodiazepines, deprescribing, withdrawal, discontinuation, cognitive behavioral therapy, acupuncture, hypnotherapy, Passiflora, complementary medicine, integrative medicine.

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